In the treatment of primary liver cancer and metastatic liver cancer， stereotactic body radiotherapy （SBRT） can be utilized to administer high doses of radiation for achieving ablative therapeutic effects. Given the singular nature of delivering high-dose radiation through SBRT， a higher level of precision is required in radiation therapy. Particularly， liver cancer is susceptible to positioning errors and respiratory motion， necessitating the implementation of respiratory motion management and image guidance techniques. However， existing accuracy verification methods for radiation therapy primarily rely on phantom studies， making it challenging to conduct in?vivo verification during treatment execution. Research has indicated that the liver exhibits corresponding morphological changes in magnetic resonance imaging following exposure to specific doses of radiation therapy， thereby serving as an indicator for assessing treatment accuracy. This article aims to discuss and analyze the principles underlying magnetic resonance imaging alterations after stereotactic body radiotherapy for liver cancer， including their manifestations， timing of appearance， evaluation methodologies for accuracy assessment， clinical challenges encountered during implementation， as well as future directions for development.

Exhaled breath analysis technology is a non-invasive， painless， safe， convenient， and efficient detection method. It holds great promise in disease screening， clinical diagnosis， assessment of disease severity， formulation of treatment plans， and prediction of disease prognosis. In recent years， this technology has rapidly advanced and has become an important tool in the management of respiratory system diseases. This article aims to provide a brief overview of the clinical applications and research progress of common exhaled breath analysis technologies in respiratory system diseases such as airway chronic inflammatory diseases and airway infectious diseases.

Objective To investigate the impact of spermidine on proliferation and apoptosis of diffuse large B?cell lymphoma （DLBCL） cell lines. Methods The impact of spermidine on cellular growth was assessed using a CCK?8 assay. Flow cytometry was employed to investigate the effects of spermidine on the proliferation and cell cycle dynamics of DLBCL cell lines， as well as to evaluate its influence on apoptosis in DLBCL cell lines， mouse splenocytes， and peripheral blood mononuclear cells （PBMCs） derived from healthy individuals. Western blot analysis was conducted to examine alterations in protein expression levels associated with apoptosis and the cell cycle following treatment with spermidine. Results The CCK?8 assay revealed a significant inhibitory effect of spermidine on DLBCL cell growth （P < 0.001）. Flow cytometric analysis demonstrated that spermidine had no impact on the proliferation or cell cycle of DLBCL cells， but significantly induced apoptosis （P < 0.001）. Spermidine exhibited a pro?apoptotic effect on mouse splenocytes （P < 0.01）， albeit weaker compared to its effect on DLBCL cells （P < 0.001）， and showed no significant pro?apoptotic effect on PBMCs. Western blot results indicated that spermidine did not influence the expression levels of cell cycle proteins CDK2 and CDK4， but enhanced the activation of Caspase?9 in A20 cells and Caspase?8 in OCI?Ly3 cells. Conclusion Spermidine induces apoptosis and suppresses cell growth in DLBCL cell lines， while exhibiting diminished or absent pro-apoptotic effects on mouse splenocytes and healthy human PBMCs， suggesting its potential as a specific inhibitor for the growth of DLBCL cell lines in vivo.

Objective To explore the effects of M1 polarization of microglia on secondary damage in the thalamus after cerebral cortical infarction. Methods A focal cortical infarct model of adult male SD rats was prepared using eletrocoagulation and randomized into Sham and model groups at different time points 1 ~ 4 weeks after surgery. Based on the assessment of neurofunctional changes in each group of rats， immunohistochemistry was used to observe the number and morphology of NeuN， GFAP and Iba-1 positive cells in （Ventral posterior nucleus of thalamus， VPN） of the ipsilateral thalamus after distal middle cerebral artery occlusion （dMCAO）. Immunofurescence was used to detect the number and morphology of M1 microglia marker （Iba-1⁺/CD68⁺ cells） and M2 microglia marker （Iba-1⁺/CD206⁺ cells） in VPN of the ipsilateral thalamus after dMCAO. Western blot was used to detect the expression levels of IL-1β， TNF-α， IL-10 and Arg-1 in VPN of the ipsilateral thalamus after dMCAO. Results The results of immunohistochemistry showed a significant decrease in NeuN positive cells and an increase in the density of GFAP and Iba-1 in the ipsilateral VPN of rats after dMCAO when compared with Sham group （P < 0.001）. Compared with sham group， the protein levels of TNFα and IL-1β were elevated in the ipsilateral VPN elevated （P < 0.05）. In addition， the model group rats exhibited higher Bederson scores， beam-walking test and adhesive removal test scores after dMCAO compared with Sham group （P < 0.05）. The numbers of M1 microglia marker （Iba-1⁺/CD68⁺ cells） were significantly increased when compared with M2 microglia marker （Iba-1⁺/CD206⁺ cells） in ipsilateral VPN of rats after dMCAO. Conclusion M1 polarization of microglia may play an essential role in secondary damage of thalamus after cerebral cortical infarction.

Objective This study explores the efficacy and underlying mechanisms of combining rhCYGB with 5-FU to target hypoxia-induced treatment resistance in liver cancer. The aim is to develop a novel combinatorial therapy strategy for improving outcomes in patients with refractory liver cancer. Methods The half-maximal inhibitory concentration （IC₅₀） of drugs on liver cancer cells under normoxia and hypoxia was determined， and dose-response curves were generated to assess sensitivity to 5-FU. The combined effects of rhCYGB and 5-FU were analyzed withCompuSyn and SynergyFinder 3.0. Tumor stem cell sphere formation assays and flow cytometry for CD133-positive cells were conducted to evaluate the impact on cancer stemness. Wound healing assays assessed the effects on migration. Results The IC₅₀ values under hypoxia exhibited a significant fold change compared to normoxia（P < 0.05）， specifically a 15.27-fold， 4.25-fold， and 2.34-fold increase for Hep3B， Huh7， and HepG2 cells respectively. Assessment of drug combination effects demonstrated a synergistic interaction between 5-FU and rhCYGB. Compared to the 5-FU monotherapy group， the combination of 5-FU and rhCYGB exerted an inhibitory effect on the formation of liver cancer stem cell spheres （P < 0.05） and significantly downregulated the proportion of CD133-positive subpopulations in Hep3B cells （P < 0.05）. Wound healing assay results revealed a synergistic inhibitory effect on the migration of Hep3B cells after 48 hours of treatment with rhCYGB combined with 5-FU undernormoxia （P < 0.05）. Conclusions The combination of rhCYGB and 5-FU demonstrates synergistic effects in liver cancer. The underlying mechanism may involve the modulation of stemness and cell migration capacity.

Objective To investigate the factors influencing gastrointestinal bleeding associated with esophagogastric fundal varices bleeding （EGVB） in patients with liver cirrhosis 5 years after endoscopic treatment. Methods A retrospective enrollment was conducted on 181 patients with liver cirrhosis who underwent endoscopic treatment with EGVB at the First Affiliated Hospital of University of Science and Technology of China from February 2017 to May 2019， followed up for a minimum duration of 5 years. The demographic characteristics including gender， age， etiology of liver cirrhosis （viral， alcoholic， autoimmune， others）， presence of ascites， hepatic encephalopathy severity （none， stage 1 ~ 2， stage 3）， portal vein thrombosis status， occurrence of liver cancer or portal hypertensive gastric disease along with other complications were recorded. Additionally， peripheral blood indexes ［aspartate aminotransferase （AST）， alanine aminotransferase （ALT）， white blood cell count （WBC）， total bilirubin （TBIL）， albumin （ALB）， platelet count （PLT）］， prothrombin time parameters ［prothrombin time （PT） and prothrombin time international normalized ratio（PTINR）］， portal vein diameter and splenic vein diameter measurements as well as Child grade assessment were collected alongside sequential treatment details and rebleeding time. According to the occurrence of rebleeding within 5 years after endoscopic treatment， the 181 cases were divided into two groups： the non?rebleeding group （n = 124） and the rebleeding group （n = 57）. Univariate and multivariate analyses were conducted to identify risk factors associated with rebleeding within 5 years after endoscopic treatment. Additionally， Kaplan?Meier analysis was performed to assess the cumulative bleeding rate at 1， 3， and 5 years. Results The results of both univariate analysis and binary logistic regression analysis revealed that elevated TBIL levels and increased portal vein diameter were significant risk factors for rebleeding within 5 years following endoscopic treatment in patients with EGVB （P < 0.05）. The Kaplan?Meier curve demonstrated that out of the 181 patients， there were 41 cases of cumulative bleeding within 1 year， 54 cases within 3 years， and 57 cases within 5 years， resulting in cumulative bleeding rates of 22.65%， 29.83%， and 31.49% respectively. Conclusions The long?term rebleeding rate remains elevated following endoscopic treatment of EGVB in cirrhotic patients， with TBIL levels and portal vein diameter identified as independent risk factors for long?term rebleeding after endoscopic treatment of EGVB in liver cirrhosis. Therefore， patients with higher TBIL levels and/or cirrhosis should be given priority for endoscopic treatment of EGVB.

Objective To compare and analyze clinical effects of three correction methods in type Ⅲnipple retraction. Methods A total of 93 patients with type Ⅲ nipple retraction were retrospectively enrolled at Clifford Hospital between May 2018 and December 2023. Based on the different surgical methods employed， they were categorized into three groups： group A （silk traction method， n = 30）， group B （areola double-flap method， n = 31）， and group C （areola single-flap method， n = 32）. The study compared the operation time， therapeutic efficacy， hemodynamic disorders， improvement in nipple appearance and function， complications， patient satisfaction， and recurrence rates among these three groups. Results The operation duration was significantly longer in group B compared to groups A and C （P < 0.05）. Group C exhibited a significantly higher total response rate than groups A and B （P < 0.05）， while no significant difference was observed between groups A and B （P > 0.05）. There were no significant differences in the incidence of hemodynamic disorders among the three groups （P > 0.05）. The improvement scores for nipple appearance and function were significantly higher in group C compared to groups A and B （P < 0.05）， with no significant difference between groups A and B （P > 0.05）. The incidence of complications was lower， satisfaction was higher， both being statistically significant， in group C compared to groups A and B （P < 0.05）， but there were no significant differences in the incidence of complications or satisfaction between groups A and B （P > 0.05）. The recurrence rate was significantly lower in group B and group C than in group A （P < 0.05）. Conclusion The correction effect of the areola single-flap method is superior to that of the silk traction method and areola double-flap method in patients with type Ⅲ nipple retraction， thereby enhancing clinical efficacy， patient satisfaction， nipple aesthetics， and functionality while reducing complications and recurrence rates.

Objective Compare and analyze the clinical efficacy and imaging differences of zero?profile interbody fusion cage and interbody fusion cage combined with titanium plate in anterior cervical discectomy and fusion （ACDF）. Methods The clinical data of 40 patients who underwent ACDF in our hospital from February 2017 to November 2021 were retrospectively analyzed. Among them， 22 patients were treated with zero?profile interbody fusion cage （zero?profile group）， and 18 patients were treated with interbody fusion cage combined with titanium plate （titanium plate group）. Record the operation time and intraoperative blood loss of the two groups. Japanese Orthopaedic Association （JOA） score， neck disability index （NDI） score and postoperative dysphagia were used to evaluate the clinical efficacy. Measure the cervical Cobb angle （C2?C7）， fusion segment Cobb angle， average intervertebral space height， and fusion segment height. Evaluate the fusion and subsidence of the cage by observing the internal and external bone bridging of the cage through postoperative CT. Results There was no significant difference in operation time and intraoperative blood loss between the two groups （P > 0.05）. The JOA score， NDI score， average intervertebral space height， and fusion segment height of the two groups after operation were significantly improved compared with those before operation （P < 0.05）. The incidence of postoperative dysphagia in the zero?profile group was significantly lower than that in the titanium plate group （P < 0.05）. The Cobb angle of the fusion segment in the zero?profile group at 3 months after operation was significantly improved compared with that before operation （P < 0.05）. There was no significant difference in the other radiographic parameters between the two groups at each follow?up time point （P > 0.05）， except for the Cobb angle of the fusion segment at 3 months after operation and at the last follow?up （P < 0.05） and the difference in the extra?fusion bone bridge （ExGBB） between the two groups at the last follow?up （P < 0.05）. Conclusions In ACDF， the clinical efficacy of zero?profile interbody fusion cage and interbody fusion cage combined with titanium plate is similar， both of which can significantly improve cervical function and postoperative imaging indicators. However， the zero?profile interbody fusion cage significantly reduced the incidence of dysphagia compared with the interbody fusion cage combined with titanium plate. In the end?stage follow?up， the former is better than the latter in improving the Cobb angle of the fusion segment and ExGBB， which is more conducive to promoting bone graft fusion. Both fuses have the risk of sinking.

Objective To investigate the correlations between IgM deposition levels，glomerular ultrastructural and clinicopathological features in primary IgA nephropathy（IgAN）. Methods Data from 155 IgAN patients were categorized into three cohorts by IgM deposition levels. We assessed differences in glomerular ultrastructure， clinical indices， MEST-C scores， and factors influencing IgM deposition levels. Results The marked IgM cohort showed higher urinary protein， IgG deposition， and T scores， with reduced serum albumin and lymphocyte counts （P < 0.05）. Logistic regression identified FPE and T score as independent factors for IgM deposition. Conclusions IgM deposition correlates with FPE severity in IgAN， suggesting its utility in assessing renal damage and guiding treatment strategies.

Objective To investigate the efficacy and short-term prognosis of the treatment of complex preauricular fistulas by double-incision tunneling combined with total resection of preauricular tissue and cartilage. Methods The data on 134 children with complicated preauricular fistula admitted to the hospital from January 2018 to July 2022 were retrospectively analyzed. According to the treatment method， they were divided into a study group （68 undergoing double-incision tunnel combined with preauricular tissue and cartilage resection） and a control group （66 receiving preauricular tissue and cartilage resection）. Both groups were followed up for one year. The conditions of surgery， pain， postoperative incision healing， aesthetics of incision healing， complications and short-term prognosis were compared between the two groups. Results There was no significant difference in the amount of blood loss between the two groups （P > 0.05）. The surgical duration was longer in the study group than in the control group （P < 0.05）. There was no significant difference in Pain Behavior Scale （FLACC） scores between the two groups at hours 4 and 24 after surgery （P > 0.05）. There was no significant difference in wound healing between the two groups （P > 0.05）. The SBSES score of the study group was higher than that of the control group （P < 0.05）. There was no significant difference in the total complication rate between the two groups （P > 0.05）. No recurrence occurred in both groups during postoperative follow-up. Conclusion Double-incision tunnel combined with resection of preauricular tissue and cartilage for preauricular fistula can completely remove fistula tissue. Incision healing is satisfactory， safe and reliable. As compared with the total excision of preauricular tissue and cartilage， double-incision tunnel combined with total excision of preauricular tissue and cartilage has more advantages in aesthetics of incision healing.

Objective To compare the outcomes of transvaginal natural orifice transluminal endoscopic surgery （vNOTES） and laparoendoscopic single-site surgery （LESS） for total uterine excision in obese patients with benign uterine lesions， and to investigate the utility of vNOTES in this patient population. Methods A total of 100 obese patients （BMI > 28.0 kg/m²） diagnosed with benign uterine lesions requiring total uterine and bilateral salpingectomy between January 2022 and January 2023 were included in this study. They were randomly assigned to two groups： the LESS group （n = 51） and the vNOTES group （n = 49）. Patient demographics， surgical duration， intraoperative blood loss， changes in hemoglobin levels， pain scores， time to first flatus postoperatively， length of hospital stay， pelvic floor function， sexual quality of life， and postoperative complications were compared between the two groups. Results The two groups did not show any statistically significant differences in terms of blood loss， pre- and postoperative hemoglobin changes， pelvic floor function， sexual quality of life， or postoperative complications （P > 0.05）. However， the vNOTES group exhibited shorter surgical durations， time to first flatus postoperatively， and length of hospital stay compared to the LESS group （P < 0.05）. Additionally， the vNOTES group demonstrated lower intraoperative pain scores than the LESS group. （P < 0.05）. Conclusions In obese patients with benign uterine lesions， vNOTES total uterine excision surgery demonstrated shorter surgical durations and postoperative hospital stays， lower postoperative pain scores， and better adherence to the principles of enhanced recovery after surgery （ERAS）， indicating its potential for broader application.

Objective To elucidate the clinical significance in facilitating timely diagnosis and treatment of RMPP in children by investigating the association between infection caused by macrolide?resistant Mycoplasma pneumoniae （MRMP） and refractory Mycoplasma pneumoniae pneumonia （RMPP） in pediatric patients. Methods The clinical data of 714 hospitalized children with refractory Mycoplasma pneumoniae pneumonia （RMPP） were retrospectively analyzed. Bronchoscopy and bronchoalveolar lavage fluid （BALF） were performed on each subject， and the BALFs were collected to detect mutation sites in the V region of 23S rRNA for Mycoplasma pneumoniae DNA. Based on the gene detection results， children with RMPP were categorized into a macrolide?resistant group and a control group （non?macrolide?resistant group）. Results A total of 714 children diagnosed with refractory Mycoplasma pneumoniae pneumonia （RMPP） were enrolled in this study， including 509 cases in the macrolide?resistant group and 205 cases in the control group. Among them， there were 369 males （54.7%） and 345 females （45.3%）. The macrolide?resistant group exhibited higher average age， fever duration， and hospitalization days compared to the control group. Furthermore， elevated levels of white blood cell count （WBC）， neutrophil percentage （NE%）， high?sensitivity C?reactive protein （hs?CRP）， lactate dehydrogenase （LDH）， and interleukin?6 （IL?6） were observed in the macrolide?resistant group when compared to the control group （P < 0.05 or P < 0.000 1）. Compared to the control group， children with macrolide?resistant Mycoplasma pneumoniae pneumonia （RMPP） exhibited higher incidences of lung consolidation， pleural effusion， necrotic pneumonic lesions， severe MPP （SMPP）/fulminant MPP （FMPP）， flocculent and viscous tracheal secretions， severe mucosal lesions （erosion， ulceration or necrosis）， bronchial inflammatory stenosis， endo?bronchial plastic phlegm plugs and extra?pulmonary complications （P < 0.05 or P < 0.0001）. Conclusions MRMP infection can contribute to the development of RMPP， potentially exacerbating respiratory conditions in affected children. Timely bronchoscopy and collection of BALF samples for accurate evaluation of respiratory tract lesions and detection of MRMP infection have significant implications for guiding precise clinical diagnosis and treatment.

Objective To explore the clinical value of NOD-like receptor pyrin domain-containing protein 3 （NLRP3） inflammasome levels combined with eosinophil cationic protein （ECP）/myeloperoxidase （MPO） ratio in predicting the recurrence of chronic rhinosinusitis after endoscopic sinus surgery. Methods 205 patients with chronic sinusitis who received treatment from the hospital from February 2018 to December 2022 after endoscopic sinus surgery were selected for prospective analysis. The patients were divided into non-recurrence group and recurrence group according to whether they relapsed one year after surgery.The factors influencing the recurrence of patients with chronic sinusitis after endoscopic sinus surgery were screened， and the predictive efficacy was evaluated by receiver operating characteristic curve （ROC）. Results The NLRP3 inflammasome level， ECP/MPO ratio， sinus CT score， Lund-Kennedy score and immunoglobulin E in the relapsing group were higher than non-relapsing group （P < 0.05）. NLRP3 inflammasome level， ECP/MPO ratio， sinus CT score， Lund-Kennedy score and immunoglobulin E were the influencing factors of postoperative recurrence in patients with chronic sinusitis （P < 0.05）. The area under the curve （AUC） values of NLRP3 inflammasome level， ECP/MPO ratio and combined prediction of postoperative recurrence in patients with chronic sinusitis were 0.823， 0.815 and 0.899， respectively （P < 0.05）， and the AUC value of combined NLRP3 was higher （P < 0.05）. Conclusion NLRP3 inflammasome level combined with ECP/MPO ratio has a high value in predicting the risk of recurrence after nasal endoscopy.

Objective To explore and compare the efficacy and safety of different transurethral enucleation procedures for treating benign prostatic hyperplasia. Methods A retrospective analysis was conducted on the clinical data of 215 patients with benign prostatic hyperplasia admitted to our hospital from January 2021 to May 2023. According to the surgical procedures， they were divided into plasma resection group （n = 81）， treated with transurethral plasma resection of the prostate， laser resection group （n = 92）， treated with transurethral laser resection of the prostate， and green laser enucleation group （n = 42）， treated with transurethral green laser enucleation of the prostate. The three groups were compared in terms of perioperative indicators （surgical time， intraoperative bleeding volume， bladder flushing time， indwelling catheter time， postoperative hemoglobin concentration， and hospital stay）， urodynamic indicators （RUV， IPSS score， Qmax， and QOL score）， and postoperative complications. Results The green laser enucleation group and laser resection group demonstrated a significantly higher total effective rate compared to the plasma electrosurgery group （P < 0.05）. The three groups showed no statistically significant difference in hospital stay （P > 0.05）， but the green laser enucleation group showed a significantly shorter surgical time compared to the other two group （P < 0.05）. The green laser enucleation group and laser resection group had superiority in intraoperative bleeding， bladder flushing time， and indwelling catheter time compared to the plasma resection group， and a significantly higher postoperative hemoglobin concentration compared to the plasma resection group （P < 0.05）. Repeated measurement analysis of variance showed that the three groups all exhibited significantly decreases in RUV， IPSS score， and QOL score （P < 0.05）， and a significantly increase in Qmax at 1 month and 3 months after surgery （P < 0.05）. The laser resection group and green laser enucleation group presented with significant decreases in RUV， IPSS score， and QOL score （P < 0.05）， and a significantly decrease in Qmax compared to the plasma resection group at 1 month and 3 months after surgery （P < 0.05）. However， the laser resection group and the green laser enucleation group had no statistically significant difference in RUV， IPSS score， Qmax， and QOL score at 1 month and 3 months after surgery （P > 0.05）. The green laser enucleation group had the lowest total incidence of postoperative complications， following by the laser resection group and plasma resection group in order （7.14% vs. 21.74% vs. 35.80%， P < 0.05）. Conclusion The three surgical procedures all have good therapeutic effects on benign prostatic hyperplasia. Transurethral laser prostatectomy and green laser enucleation have superiority to those of transurethral plasma resection of the prostate in efficacy and safety， and they can promote early recovery of patients. Transurethral green laser enucleation is the best in safety.

Objective To investigate the clinical characteristics and risk of lymph node metastasis in patients with multiple primary lung adenocarcinoma nodules compared to those with a single lung adenocarcinoma nodule. Methods Retrospective analysis was conducted on 212 patients who underwent thoracic surgery at Zhujiang Hospital of Southern Medical University from 2022 to 2023. This included 149 cases of single lung adenocarcinoma nodules and 63 cases of multiple primary lung adenocarcinoma nodules. After propensity score matching， a comparison was made between the two groups in terms of imaging features， tumor serological indicators， pathological immunohistochemistry， and lymph node metastasis rate. Additionally， binary logistic regression was employed to explore the differences in lymph node metastasis rate between single and multiple nodules. Results After propensity score matching， statistically significant differences were observed in the Avr value of CT （P = 0.001）， KI?67 expression level （P < 0.001）， PD?L1 expression level （P = 0.002）， and lymph node metastasis rate （P = 0.030） between the two groups. However， there were no statistically significant differences in nodule type， imaging features such as lobulation and vascular clustering， tumor serological indicators including CEA and NSE， ALK positive rate， and SYN positive rate. The variables with significant differences （Avr， Ki?67， PD?L1） were identified through Spearman test for correlation analysis. Binary logistic regression analysis was performed using lymph node metastasis as the dependent variable and single or multiple nodules as categorical covariates along with the three correlated variables included as independent variables interactively. The results showed that the probability of lymph node metastasis in multiple primary lung adenocarcinoma nodules was 80.8% lower than that in single lung adenocarcinoma nodules （RR = 0.192， P = 0.042）. Conclusions Multiple primary adenocarcinoma nodules exhibit a less aggressive biological behavior compared to solitary adenocarcinoma nodules， resulting in a reduced likelihood of lymph node metastasis. For cases involving multiple primary lung adenocarcinoma nodules， the implementation of aggressive surgical protocols is not advisable； instead， personalized treatment plans should be developed based on comprehensive evaluations including intraoperative frozen pathology and imaging.

Objective This study is to explore the clinical efficacy and common adverse reactions of PEG?IFN α ?2b combined with TMF and TDF in the treatment of hepatitis B liver fibrosis， and provide more clinical reference for the treatment of chronic hepatitis B. Methods From January 2022 to December 2023， we selected 130 patients with chronic hepatitis B liver fibrosis who were admitted to Kunming Third People's Hospital. Divided into TMF combined group and TDF combined group， the virus reduction level， virus response rate， liver fibrosis four items， instantaneous elastography （FibroScan） and other indicators were compared between the two groups of patients after 48 weeks of treatment. The changes in liver fibrosis grading and adverse reactions before and after treatment were also compared. Results After 48 weeks of treatment， the TMF combined group showed a significant increase in HBV DNA seroconversion rate and HBeAg seroconversion rate compared to the TDF combined group， with statistical significance （P < 0.05）. However， there was no statistically significant difference in HBsAg seroconversion rate between the two groups of patients （P > 0.05）. After 48 weeks of treatment， the TMF combined group showed more significant efficacy in reducing the levels of HA， PC Ⅲ， Ⅳ?C， and LN， with a significant difference （P < 0.05）； After 48 weeks of treatment， both groups of patients showed improvement in the degree of liver tissue fibrosis. Compared with the TDF combined group， the TMF combined group had a more significant effect on tissue improvement. After 48 weeks of treatment， the incidence of dyslipidemia， hypothyroidism， and diarrhea was higher in the TMF combined group than in the TDF combined group （P < 0.05）； After 48 weeks of treatment， there was no statistically significant difference in the incidence of gingival bleeding， anemia， and thrombocytopenia between the two groups of patients （P > 0.05）； The incidence of elevated uric acid and joint pain in the TDF combined group was higher than that in the TMF combined group after 48 weeks of treatment （P < 0.05）. Conclusion TMF combined with PEG?IFN α ?2b has better clinical efficacy in treating chronic hepatitis B， strong antiviral ability， greater inhibition of liver fibrosis， good drug safety， better prognosis， and can provide more effective medication basis for clinical cure of hepatitis B.

Objective To investigate the efficacy and safety of a single induction dose of cyclopofol in painless four?dimensional hysterosalpingography， this study aims to assess its academic significance and adherence to Nature journal's publication standards. Methods A total of 120 patients admitted to Guangdong Reproductive Hospital between February 2022 and December 2022， requiring painless vaginal four?dimensional ultrasound hysterosalpingography， were selected as the study population. Random selection was performed with 40 patients in each group. The dosage of cyclopofol administered was 0.3 mg/kg （C1 group）， 0.5 mg/kg （C2 group）， and 0.7 mg/kg （C3 group）. Heart rate （HR）， mean arterial pressure measured non?invasively using a cuff， time to wake after surgery， and incidence of adverse reactions were observed at three time points： before examination （T1）， during contrast agent injection （T2）， and after examination （T3）. Results There were no significant differences in heart rate （HR） and mean arterial pressure （MAP） between T1 and T3 among the three groups （P > 0.05）. However， at T2， group C1 exhibited significantly higher HR and MAP compared to group C2 （P < 0.05）， while there was no statistically significant difference in HR and MAP between group C2 and C3 at T2 （P > 0.05）. The duration of wakefulness was shorter in group C2 than in group C3 （P < 0.05）， but there was no statistical significance in wakefulness duration between group C1 and C2 （P > 0.05）. The incidence of adverse reactions was lower in group C2 （10.0%） compared to both group C1 （32.5%） and group C3 （37.5%） with statistical significance （P < 0.05）. Conclusion The administration of cyclopofol at a dosage of 0.5 mg/kg exhibits notable advantages in painless four?dimensional hysterotubal ultrasonography， including effective sedation， prompt wakefulness， and a low occurrence rate of adverse reactions.

Objective To assess the prognostic significance of serum cystatin C （CysC） in combination with bedside renal ultrasound for patients diagnosed with sepsis-induced acute kidney injury （AKI）. Methods The study cohort comprised 134 patients with sepsis-induced AKI who were admitted to our hospital between October 2019 and October 2023. Based on the 30 day prognosis， the patients were categorized into a survival group （n = 93） and a death group （n = 41）. Collected clinical data included gender， age， heart rate， underlying diseases， treatment modalities， duration of hospital stay， basic biochemical indicators， and Acute Physiology and Chronic Health Evaluation Ⅱ（APACHEⅡ） scores. Renal function markers such as serum creatinine （SCr）， blood urea nitrogen （BUN）， and cystatin C levels were measured； renal blood flow resistance index （RI） was assessed using bedside routine ultrasound. Cox regression analysis was employed to evaluate factors influencing poor prognosis in patients with sepsis-induced AKI while analyzing the prognostic assessment value of combining cystatin C with bedside renal ultrasound through ROC curves. Results The death group exhibited significantly higher APACHEⅡ scores， SCr， BUN， CysC levels， and RI （all P < 0.05） compared to the survival group. Cox regression analysis revealed that both CysC levels and RI were significant prognostic indicators （P < 0.05）. ROC curve analysis demonstrated that the combined assessment of CysC levels and RI yielded a high diagnostic accuracy of 97.5% in predicting outcomes for patients with sepsis-induced AKI. Conclusion CysC levels and bedside renal ultrasound can serve as prognostic indicators for patients with sepsis-induced acute kidney injury （AKI）， thereby guiding clinical treatment.

Objective To assess the correlation between wall shear stress （WSS） in the internal carotid artery and neovascularization of carotid plaque using color ultrasound imaging. Methods A total of 99 patients diagnosed with carotid atherosclerotic plaque （CAP） were prospectively selected between July 2021 and September 2023. All patients underwent comprehensive carotid imaging including color ultrasound， conventional ultrasound， and carotid contrast-enhanced ultrasound （CEUS）. Based on the presence or absence of intraplaque neovascularization （IPN） in patients with ischemic cerebrovascular disease， they were categorized into the forming group and non-forming group. Comparative analysis was performed on wall shear stress （WSS） values and clinical data between these two groups to identify factors influencing IPN formation in the carotid artery among patients with ischemic cerebrovascular disease， while also assessing the predictive value of average WSS for IPN formation. Results Among 99 patients with ischemic cerebrovascular disease， carotid artery IPN was observed in 23 cases， while the remaining 76 cases did not exhibit carotid artery IPN. The formation group demonstrated significantly higher levels of white blood cell count， plaque thickness， plaque length， stenosis ≥ 70% ratio， C?reactive protein， and matrix metalloproteinase?9 to tissue inhibitor of matrix metalloproteinase?1 （MMP?9/TIMP?1） ratio compared to the non?formation group （P < 0.05）. Logistic regression analysis revealed that mean wall shear stress （OR = 4.545； 95% CI： 1.998 ~ 10.339）， stenosis severity （OR = 2.765； 95% CI： 1.215 ~ 6.290）， C?reactive protein levels （OR = 3.047； 95% CI： 1.339 ~ 6.930）， and MMP?9/TIMP?1 ratio （OR = 3.543； 95% CI： 1.558 ~ 8.060） were significant influencing factors for carotid artery IPN formation in patients with ischemic cerebrovascular disease （P < 0.05）. The receiver operating characteristic curve （ROC） analysis revealed that the area under the curve （AUC） for average WSS in predicting carotid artery intraplaque neovascularization formation in patients with ischemic cerebrovascular disease was 0.797 （P < 0.05）. At an average WSS of 10.23 dyne/cm²， the maximum specificity and sensitivity were determined to be 85.53% and 78.26%， respectively. Conclusion The mean WSS of internal carotid artery has a good value in predicting the formation of carotid IPN in patients with ischemic cerebrovascular disease.

Objective To explore the clinical application value of MRI fat quantification parameter ［vertebral bone marrow fat fraction （FF）］ combined with 25?hydroxyvitamin D ［25（OH）D］ in predicting fracture risk in patients with osteoporosis. Methods A total of 90 patients with osteoporosis who were admitted to the hospital from January 2023 to April 2024 were selected as the subjects. Among them， 50 patients with osteoporotic vertebral compression fractures were included in the fracture group， and 40 patients without fractures were included in the control group. All patients underwent the iterative decomposition of water and fat with echo asymmetry and least?squares estimation （IDEAL?IQ） method of MRI to measure the FF of each vertebra among L_1?5 and the average FF of L_1?5. Serum 25 （OH） D level was detected by electrochemiluminescence method. FF and serum 25（OH）D levels of the two groups were compared. The correlation of FF， 25（OH）D and bone mineral density （BMD） was analyzed. Multivariate logistic regression analysis was conducted to screen the risk factors for fracture in patients with osteoporosis. Receiver operating characteristic （ROC） curves were used to evaluate the predictive value of FF， 25（OH）D， and their combination for fracture in patients with osteoporosis. Results Patients in the fracture group were older than those in the control group. BMD and serum 25（OH）D level were lower than those of the control group （P < 0.05）. The FF of L₂ and average FF of L_1?5 in the fracture group were higher than those in the control group （P < 0.05）. Correlation analysis results showed that the FF of L₂ and the average FF of L_1?5 were negatively correlated with BMD （P < 0.05）， while serum 25 （OH） D level was positively correlated with BMD （P < 0.05）. Multivariate logistic regression analysis showed that age and FF of L₂ were independent risk factors for fracture in patients with osteoporosis， while BMD and 25（OH）D were protective factors （P < 0.05）. ROC curves indicated that the AUC values of FF of L2 and 25（OH）D for predicting fracture were 0.714 （95% CI： 0.606 ~ 0.822） and 0.774 （95% CI： 0.672 ~ 0.876）. The AUC of joint prediction was 0.923 （95% CI： 0.867 ~ 0.978）， which was significantly larger than that of separate prediction （P < 0.05）. Conclusions FF of L2 and serum 25（OH）D are related to fracture in patients with osteoporosis. Age and BMD are factors influencing the occurrence of fracture in patients with osteoporosis. FF of L2 and 25（OH）D have certain predictive value for fracture risk in patients with osteoporosis， and combined detection of the two can improve predictive efficiency.

Objective To analyze the values of peripheral blood red blood cell distribution width （RDW）， neutrophil （NEU） to lymphocyte （LYM） ratio （NLR）， fibrinogen （FIB） to albumin （ALB） ratio （FAR） and surfactant protein A （SP-A） in evaluating patient condition and risks of acute exacerbation of COPD. Methods A total of 200 patients with COPD admitted to Hebei University Affiliated Hospital from January 2021 to December 2023 were selected as study subjects. All the patients had follow-up visits in the outpatient department within the past three months. According to the presence or absence of acute exacerbation， they were divided into exacerbation group （n = 96） and non-exacerbation group （n = 104）. Meanwhile， 50 healthy volunteers were assigned to a control group. Peripheral blood RDW， NEU， LY， FIB， ALB and SP-A in the three groups were compared. NLR and FAR were calculated. The correlation of RDW， NLR， FAR， and SP-A with the severity of AECOPD was analyzed. ROC curves were used to analyze the values of RDW， NLR， FAR， and SP-A in evaluating the risks of acute exacerbation of COPD. Multivariate logistic regression analysis was conducted to identify the risk factors for AECOPD. The differences in RDW， NLR， FAR， and SP-A were compared among the patients with different prognoses. Results Peripheral blood RDW， NEU， NLR， FIB， FAR and SP-A were higher in the exacerbation group than in the non-exacerbation group， whereas LYM and ALB were lower （P < 0.05）. Levels of RDW， NLR， FAR and SP-A were higher in the patients with grade Ⅲ AECOPD than those with grade Ⅱ or grade Ⅰ AECOPD （P < 0.05）. RDW， NLR， FAR， SP-A， and grade of patient condition in patients with AECOPD were positively correlated in pairs （P < 0.05）. The sensitivity， specificity and area under the ROC curve of combined prediction of AECOPD using RDW， NLR， FAR and SP-A were 0.798 and 0.830 （95%CI： 0.738 ~ 0.922）， all of which were superior to prediction using a single indicator. Multivariate analysis found that smoking， RDW > 14.33%， NLR > 2.80， FAR > 0.08， and SP-A > 2.21 ng/mL were risk factors for acute exacerbation of COPD （P < 0.05）. RDW， NLR， FAR， and SP-A in the readmission group within 30 days after discharge were higher than those in the non-readmission group （P < 0.05）. Conclusions RDW， NLR， FAR， and SP-A are closely related to the patient condition of COPD， and can help to predict the risk of acute exacerbation and prognosis. Therefore， they are worthy of monitoring in clinical practice.

S100A9 is an important alarmin in vivo， which plays a role in regulating inflammation and tumorigenesis. Recently， many studies have also explored the biological function and related mechanism of S100A9 in renal diseases， including acute kidney injury， chronic kidney disease， renal stone， renal transplantation， renal tumor， renal cyst， and urinary infection. They pointed out the potential role of S100A9 as a new diagnostic and therapeutic biomarker for renal diseases. In the current study， we conduct a review of these findings and summarize possible future study directions， which aims to help people understand the impact of S100A9 on renal diseases.

Rheumatoid arthritis （RA） is a chronic and progressive autoimmune disease. Current clinical treatments for RA often exhibit inadequate drug responses and severe adverse effects， underscoring the necessity for alternative therapies. Baicalin， a flavonoid derived from Scutellaria baicalensis roots， possesses anti-inflammatory， antioxidant， and immunomodulatory properties. Research suggests that baicalin can inhibit the release of inflammatory mediators， thereby reducing inflammation. Moreover， it demonstrates antioxidant effects by decreasing reactive oxygen species production and mitigating synovial damage induced by oxidative stress. Baicalin may impede the activation of inflammatory cytokines through pathways such as NF-κB， MAPKs， and JAK-STAT signaling cascades while inducing apoptosis， regulating immune cell activity， and balancing immune mediators to impact synovitis progression. Clinically， both monotherapy with baicalin or its combination with other formulations have exhibited efficacy and safety profiles. The advancement in targeted drug delivery systems has improved its bioavailability further suggesting promising clinical applications. This review provides an overview of research progress on baicalin's mechanisms in inhibiting RA synovitis along with its clinical applications.

Cardiovascular disease （CVD） poses a significant public health challenge in China， with both incidence and mortality rates increasing. The role of macrophage metabolic reprogramming in CVD has garnered growing attention due to its direct connection to the pathogenesis of the disease and potential therapeutic interventions. Glutamine （GLN）， a fundamental energy source for macrophages， plays a crucial role in this context. Alterations in GLN metabolism have substantial effects on macrophage phenotypic transformation， functional performance， and adaptive responses in the context of CVD. Therefore， this review aims to investigate the impact of GLN metabolic reprogramming on macrophages' contribution to the pathogenesis of CVD， specifically focusing on its involvement in atherosclerosis， myocardial infarction， and other cardiovascular conditions. Additionally， it will evaluate the potential of targeting GLN metabolic pathways as a therapeutic strategy.

Intervertebral disc degeneration （IDD） is the primary etiology of various chronic spinal disorders， characterized by clinical symptoms including low back pain and acute lower limb radicular pain. In recent years， due to accelerated population aging and lifestyle changes， there has been a significant increase in the incidence of IDD， particularly among younger individuals. This not only severely impacts patients' quality of life but also imposes substantial economic and medical burdens on society. Consequently， effective prevention and treatment strategies for IDD have become urgent medical priorities. Previous studies have demonstrated that cellular senescence of intervertebral disc cells plays a crucial role in the initiation and progression of IDD. As such， therapeutic interventions targeting senescent intervertebral disc cells， such as anti?senescence drugs， gene editing techniques， and stem cell therapy， are emerging as promising research areas. This review article comprehensively explores the molecular mechanisms underlying cellular senescence in IDD while discussing diverse therapeutic approaches and their latest advancements pertaining to senescent cells. The aim is to provide novel research insights and potential therapeutic targets for preventing and treating IDD while offering valuable references for future investigations.